Organization · NPI-2

Edward P. Costlow, MD PA

Internal Medicine · Timonium, MD

NPI number1104205764

StatusActive

Last updated in NPPESMay 28, 2015

Details

NPI: 1104205764
Entity type: Organization (NPI-2)
Legal business name: Edward P. Costlow, MD PA
Organization subpart: No
Enumeration date: May 28, 2015
Last updated: May 28, 2015

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
207R00000X	Internal Medicine	D0019503	MD	Yes

Practice location

10 Gerard Avenue
Suite 214
Timonium, MD 21093-3206

Phone 410-561-1585 · Fax 410-252-0814

Mailing address

10 Gerard Avenue
Suite 214
Timonium, MD 21093-3206

Phone 410-561-1585 · Fax 410-252-0814

Authorized official

Edward P. Costlow
President
4105611585

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